The California state legislature passed a bill that will prevent unexpected out-of-network medical bills. The bill declares that patients who receive non-emergency care in in-network facilities would only have to pay in-network cost sharing. This would eliminate surprise billing from out-of-network claims. Suitable provider networks will also be more strictly demanded of health plans. A […]
The U.S. Senate Committee on Finance released a whitepaper, which addresses proposed reforms of the Stark law (which prohibits physicians from referring Medicare beneficiaries to an entity in which they have a financial relationship for designated health services). The whitepaper asserts that support for reform of the Stark Law has grown tremendously in recent years, […]
The Joint Commission (which accredits and certifies healthcare organizations and programs) announced in their newsletter that they are temporarily upholding their ban on clinicians’ use of messaging and text tools. In 2011, the Joint Commission said that it was “not acceptable for physicians or licensed independent practitioners to text orders for patient care, treatment or […]
On July 28th, 2016, the Department of Justice released a report stating that the Lexington County Health Services District will pay $17 million for violations of the Physician Self-Referral Law (the Stark Law) and the False Claims Act. The Department alleged that Lexington Medical Center (“LMC”) violated the Stark Law (which prohibits physicians from referring […]
Attorney General Eric T. Schneiderman and United States Attorney Preet Bharara announced a $2.95 million fraud settlement with three hospitals in the Mount Sinai Health System resulting from Medicaid overpayments. A whistleblower alleged that Mount Sinai Beth Israel, Mount Sinai St. Luke’s, and Mount Sinai Roosevelt knowingly retained over $844,000 in Medicaid overpayments beyond the […]
On July 25th, The Centers for Medicare and Medicaid Services (CMS) released a new proposed rule which could materially change the Medicare payment model for hospitals in 98 randomly selected metropolitan statistical areas. The proposed rule contemplates the creation of new bundled payment models for cardiac care, in addition to the extension of the existing […]
All healthcare organizations should maintain an emphasis on compliance not on an episodic basis (e.g., in response to an enforcement-related development). Rather, an institutional commitment to compliance should be an integral part of an organization’s culture, with appropriate resources and leadership support. In connection, it is instructive to revisit the principles of the DOJ’s ‘Yates […]
On June 27th, 2016, a proposed rule was published in the Federal Register that could adversely affect home healthcare agencies. The Centers for Medicare & Medicaid Services (CMS) proposed significant reductions in Medicare reimbursements for home healthcare agencies. Such reductions would take effect in 2017, totaling $180 million, or about a 1% cut in funding. […]
On July 28th, 2016, researchers from Harvard, in conjunction with researchers from several hospitals, published a study in the BMJ which found that the implementation of new electronic health records (EHRs) systems does not have material repercussions on patient care in hospitals. The study observed 17 hospitals implementing new EHRs, along with a control group […]
On July 29, 2016, the Centers for Medicare & Medicaid Services (“CMS”) announced that it is expanding statewide (and extending for an additional six (6) months), the temporary enrollment moratoria on new Medicare Part B home health agencies (“HHAs”) in Florida, Texas, Illinois, and Michigan. The statewide expansion also applies to Medicaid and Children’s Health […]
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